Factors related to substance use development in young American Indian adolescents

描述(申请人提供)：美洲印第安人青少年比美国许多其他群体更早开始使用毒品、烟草和酒精，早期使用是长期和有问题的使用风险的明显标志。药物使用问题，包括滥用和依赖问题，有很好的记录。然而，尽管为应对这些差距作出了许多预防努力，但这些差距仍然明显。我们的目标是更好地了解年轻的美国印第安人青少年中的紧急药物使用情况，并确定可能为预防提供机会之窗的风险和保护因素。利用对其他人群的研究得出的理论，加上我们对老年美洲印第安人物质使用的了解，我们确定了一个理解这一人群早期物质使用发展的综合框架。这一框架结合了应激性生活事件和青春期早期的影响，由同伴影响介导，并由父母养育和文化因素共同调节；我们的工作将探索这些因素对早期物质使用的独特和综合影响。虽然这一系列的影响中的一些已经在美国印第安人中进行了研究(压力、同龄人、文化)，但其他影响只得到了粗略的关注(青春期早期、育儿)。因此，要为美国印第安人社区的青少年提供可能成功的基于经验的预防计划，还有很多工作要做。我们有一个独特的机会，在一个物质问题发生率特别高的保留社区探索这些对早期物质使用的影响，建立在对我们目前在这个社区实施的性风险预防计划的纵向评估的基础上。在设计性风险研究的调查工具时，我们利用这个机会也包括了与早期药物使用相关的措施；因此，我们现在掌握了数据，将使我们能够前所未有地了解该人群早期药物使用的发展情况。我们将解决以下4个具体目标：1)扩展对美国印第安人青年中毒品、烟草和酒精使用发展到青春期早期的描述；2)估计应激事件与这一人群中早期物质使用发展之间的关系；3)确定青春期早期是否与早期物质使用有重要关系；探索青春期早期如何与其他应激源相互作用影响风险，以及异常同伴影响如何中介这些联系；以及4)探索父母教养和与部落文化的联系如何改变青少年早期物质使用的风险。这项工作将解决高危和研究不足人群中的一个重大问题，使用一种利用现有数据的方法，并以创新的方式建立现有的物质使用开发模式，有望推动该领域的发展。 公共卫生相关性：这项研究的目标部落社区的年轻人比美国其他人患上药物使用问题的风险相对更大。随着我们更多地了解这些问题是如何在这一人群的青春期早期出现的，我们将更有能力确定预防干预努力的最佳时机和战略。这项工作还将有助于物质使用发展的理论模型，并扩大我们对与早期使用相关的因素的理解，也可能对其他人群产生影响。

DESCRIPTION (provided by applicant): Use of drugs, tobacco, and alcohol starts earlier among American Indian adolescents than in many other groups in the U.S. and early use is a clear marker of risk for prolonged and problematic use. Significant disparities in substance use problems, including abuse and dependence, are well documented. Yet despite numerous prevention efforts in response to these disparities, they remain pronounced. Our goal is to better understand emergent substance use among young adolescent American Indians and identify risk and protective factors that may provide windows of opportunity for prevention. Using theories emanating from research with other populations, supplemented with what we know about substance use among older American Indians, we have identified an integrative framework for understanding early substance use development in this population. This framework incorporates the effects of stressful life events and early puberty, mediated by peer influences, and moderated by both parenting and cultural factors; our work will explore both the unique and combined effects of these factors on early substance use. While some of this array of influences have been examined among American Indians (stress, peers, culture), others have received little more than cursory attention (early puberty, parenting). Thus, much work remains to be done to inform the kind of empirically based prevention programs that are likely to be successful for young adolescents in American Indian communities. We have a unique opportunity to explore these influences on early substance use in a reservation community that has particularly high rates of substance problems, building on a longitudinal evaluation of a sexual risk prevention program that we are currently implementing in this community. In designing the survey instrument for the sexual risk study, we took advantage of the opportunity to include measures relevant to early substance use as well; thus, we now have data in hand that will allow us an unprecedented look at early substance use development in this population. We will address the following 4 Specific Aims: 1) Extend descriptions of the development of drug, tobacco, and alcohol use among American Indian youth into early adolescence; 2) estimate the relationship between stressful events and early substance use development in this population; 3) determine whether early puberty has an important relationship to early substance use; explore how early puberty interacts with other stressors to impact risk and how deviant peer influences mediate these links; and 4) explore how parenting and connection to tribal culture modify risk for early adolescent substance use. This work will address a significant problem in a high-risk and understudied population, use an approach that capitalizes on extant data, and build on existing models of substance use development in innovative ways that promise to move the field forward. PUBLIC HEALTH RELEVANCE: Youth in the tribal community targeted in this study are at relatively greater risk than others in the U.S. for developing substance use problems. As we learn more about how these problems emerge in early adolescence in this population, we will be better equipped to determine optimal timing and strategies for preventive intervention efforts. This work will also contribute to theoretical models of substance use development and broaden our understanding of factors related to early use, with likely implications for other populations as well.